Social work students’ experiences of using the Egan Skilled Helper
model
Abstract
This paper aims to assess the value of the Egan Skilled Helper model in
helping social workers in training to develop their communication skills with
service users. The model was taught to first year BSc Social Work students.
During their subsequent first assessed practice placement fifteen volunteers
participated in focus groups. Here they discussed how useful the Egan model
was as a communication and problem management tool for working with
service users. A key finding is that students were able to transfer their skills
learning into practice. Further findings are that students improved their
communication skills and were better able to place service users at the centre
of decision making. The implications of these findings for social work training
are discussed together with some of the challenges of working with the model.
Key Words: communication skills, Egan model, service user
empowerment, social work, teaching and learning.
Introduction
This paper examines how learning the Egan Skilled Helper model equips BSc
Social Work students with effective communication skills which place service
users at the centre of the helping process. An additional aim is to find out
whether this learning can be transferred into practice.
Helping students to develop effective, empathic communication skills is an
established tradition within social work teaching programmes. However, there
is little research which explores the process and effect of teaching and
learning in terms of communication skills and their theoretical base. Trevithick
et. al. (2004) undertook for the Social Care Institute for Excellence a
knowledge review of teaching and learning of communication skills in social
work education. In their review Trevithick et. al. found that out of 8023
relevant papers only 16 addressed a theoretical underpinning to
communication skills development. No papers were identified that
commented on students’ experience of different communication models or
their preferences. Trevithick et. al. (2004) found there was little evidence of
evaluation of underpinning knowledge being carried out and even less
consideration relating to how successful the transfer of learning is into
practice. Trevithick et. al. argue that skills learning needs to be based on a
proven knowledge base that is relevant to social work and that skills learned
should be integrated into practice learning. The Social Work Taskforce
Report (2010: 21) emphasises the importance of social workers being able to
work in a person-centred manner ‘to support people to manage their own
affairs where possible and to assist in finding solutions which balance choice
and control for the individual.’
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Social work students commonly and mistakenly believe their role is to tell
service users what to do. The Skilled Helper model, developed by Gerard
Egan, was chosen for this study because it specifically addresses this values
issue. The model helps students to enable service users to take responsibility
for their own decision making. The three-stage model is complex and
cumulative in its development of skills. It emphasises the importance of
developing empathic relationships with service users, describes how to
encourage people to talk about their lives and to establish exactly what their
needs are. Solutions to problems are then sought together. Egan refers
throughout his work to ‘clients’ rather than ‘service users’ and this paper uses
these terms interchangeably.
The overall project has been influenced by a number of papers which
investigate social workers’ use of empathy and the teaching of communication
skills. Forrester et. al. (2008: 41-51) highlighted the importance of empathic
responding skills in social work and especially in forming good working
relationships with service users and their families. Their findings established
that social workers who were skilled in using empathic responses encouraged
parents to be much more open about what was happening in their families
than social workers who lacked these skills. Forrester et. al. commented that
most social workers did not use empathy and reflection or summarising skills,
favouring instead interventions which consisted in the main of a series of
closed questions. They found that questions outnumbered complex empathic
reflections by more than fifteen to one. Complex reflections are where
information, feelings, behaviours and thoughts from input other than the
immediately preceding sentence from the client is reflected back. These were
rarely used. Forrester et. al. emphasised the importance of raising concerns
in a climate which highlights to service users their existing strengths, a factor
which is seldom prioritised by social workers. The authors found a
relationship between the use of complex reflections and increased client
disclosure. They concluded that raising concerns in an empathic manner
would increase social workers’ likelihood of keeping and maintaining their
relationship with both the parent and child.
The importance of empathic responding is also highlighted in a survey of
communications skills teaching undertaken by Dinham et. al. (2003) who
stressed the importance of understanding the problems of service users. The
authors also emphasised the essentiality of a coherent knowledge framework
to underpin skills teaching and learning. They indicate that the framework
should have a well established base of values and principles that encompass
service user empowerment, i.e. working with service users to produce agreed
outcomes. In their work with children with disabilities, Woodcock and
Tregaskis (2008) highlighted the need for social workers in training to develop
active listening skills which help parents to express their feelings of anger and
frustration in a safe and non-judgemental environment. The authors focused
on the finding from Trevithick et. al. (2004) which established the centrality of
communications skills teaching within the social work degree. Woodcock and
Tregaskis agreed with Trevithick that a lack of an underpinning knowledge
base when teaching communications skills was a serious omission and if this
was addressed, it would enable skills to be applied more easily in different
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settings. This point was also raised by Moss et. al. (2007:711) whose
research found that ‘communication skills have been taught but not reflected
upon; experienced but not theorised.’
The Egan Skilled Helper model provides an underpinning framework which
provides structure for students in their communication with service users.
Egan (2010) draws from a number of theorists in presenting his model,
including Carl Rogers who, as Egan states in an interview with Sugarman
(1995), was highly influential. Rogers writes at length about the power of
empathic responding and how difficult it is to accomplish. However, this one
skill is the key factor that enables the client to grow and change in a climate of
understanding or a good attempt at understanding (Rogers, 1961). While
Egan draws widely from Rogers’s theory in his analysis of the importance of
building a non-judgemental relationship with the client in stage one of his
model, he nevertheless states clearly in his interview with Sugarman that
empathic responding, unconditional positive regard and congruence are not
enough to evoke change. As a result of this thinking, Egan developed his
Skilled Helper model which emphasises both the relationship and client
action. Within the model, stage one skills involve finding out what is currently
going on for the client. The client is listened to with empathy; challenging skills
are used, again with empathy not only to help the client learn about their own
ways of being but also to help them acknowledge and build on their own
strengths. In stage two, the preferred picture is identified and goals devised.
At all times the client is encouraged to state what they want or need that might
help them. Finally, in stage three, the client, with assistance from the helper,
develops strategies to achieve their goals. Using the model may enable the
student social worker to maintain a client-centred approach by empathically
responding to service users, challenging them appropriately and placing them
at the centre of decision making. The study which forms the basis for this
paper sets out to investigate the way that students make use of this model in
practice.
Study aims and methodology
This is a small scale study, the aim of which is to assess how valuable the
Egan Skilled Helper Model is in helping social workers in training to develop
their communication skills. The study primarily explores ways of keeping the
service user at the centre of decision making. The study also investigates
whether learning was effectively transferred into practice with service users.
The model was taught to two different groups. The first comprised full-time
social work students (who had little experience of working with service users)
and the second consisted of part-time students on the employment-based
course (who had substantial experience and held a case-load). Both groups
learned the model within the Communicating and Engaging with Others
module.
Methodology: Full-time students
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The model was taught to the full-time students in the term prior to their first
practice placement. The module consisted of five full days of workshops, over
a five week period, where students learned and practised the model with each
other. Six groups, 115 students in total, attended. On the final day of the
module, a request was made to the whole group for volunteers to take part in
focus group sessions which would be held during their first social work
practice placement. The objective was for students to employ the Egan
model with service users during their placement and reflect on how the model
had helped them to place decision making control with service users.
A limitation of the study is that only five students from this group (three
women and two men) subsequently took part in each of four focus groups. All
the students were white British (a further limitation), and aged in their twenties
and thirties. None of the students had any previous social work experience.
In the focus groups, students gave feedback on how useful they had found
the model. The sessions lasted between 30 and 60 minutes and were
recorded electronically and then transcribed.
Approval for the project was given by the Ethics Committee at the University
of Lincoln. The students maintained the confidentiality of service users with
whom they worked and no information was used which would have identified
any individual.
Methodology: Part-time, employment-based students
A separate group of ten part-time students taking part in this study were dayreleased from their workplaces and already held a case load of service users.
These students studied and practised the model in a similar way to the fulltime students over a period of four weeks for one day per week. A request
was made for volunteers to participate in one focus group session one month
after the module finished. All ten students (eight women and two men, all
white British with an average age of 30) agreed to take part. In the focus
group they reflected on their experience of using the model with service users
and commented on how it had changed their practice. The session lasted for
one hour and was again recorded electronically. Participants in this group
had considerably more experience of working with service users than the fulltime group.
A distinction is made between the two groups in the presentation of the data.
This is because the employment-based students already had an existing
relationship with service users and were changing the way they used
communication skills. This contrasted with the full-time students who were
beginning their first practice placement and thus forming new relationships.
Methodology applicable to both groups
Participants of both focus groups were asked to comment on the following:
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


How had students developed their communication skills as a result of
learning the Egan model?
What impact did using the model have on placing the service user at
the centre of the helping process?
How effective was the transfer of knowledge from the classroom into
practice?
An oral method of collecting data as opposed to written feedback was chosen
for the study because it placed less pressure on students and at the same
time promoted a far more detailed and dynamic response which was in line
with the model itself. All of the participants were keen to contribute their
experiences to the study.
Findings
The students who took part in this study were working in a variety of settings,
some statutory, some voluntary. In order to maintain confidentiality,
quotations from the full-time students are given the prefix ‘F’ and the
employment-based, part-time students are prefixed with ‘P’.
How students developed their communication skills as a result of
learning the Egan model
The importance of having a framework to follow
The first point raised by the students concerned how the model helped them
to develop confidence in their communication skills and understand how their
relationship with the service user was progressing. A factor that contributed
to developing students’ confidence was having a ‘map’ to follow. Egan (2010)
writes about helpers holding the model in their heads as a map so they know
where they are going with it and this was echoed by a student from group F
who stated:
‘It’s my bible that guides me to be the way I want to be. It’s good.’
This was also confirmed by another group F student who stated that having a
model from which to work was useful:
‘It has definitely helped having a model in your head when doing
assessments, when we were first told we would be doing assessments
that’s the first thing I thought about. It was worth learning.’
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Developing relationships
The students reported that the Egan model also helped them to gain rapport
with service users. As mentioned previously, Egan’s humanistic relationship
building skills are taken from Carl Rogers’s (1961) work where Rogers states
that it is the attempt at empathy that develops the relationship rather than
getting it right. He states that the client will soon clarify what they really feel
and mean if the helper tries to be empathic. The following point from a group
F student illustrated his developing skills:
‘The first time I tried to use an empathic response she replied ‘of
course it isn’t!’ So I thought, ‘OK, she’s put me right’. I know it is about
having a go at being empathic though.’
As stated, students from the part-time Employment-based BSc in Social Work
were more experienced in working with service users and already had their
own ways of working. One student from this group demonstrated the effect of
learning active listening skills from the Egan model:
‘I used the model with the whole family. What I found was that they all
got a chance, without anybody criticising them, to say what they felt
and to just have someone there as a medium to sit and allow them to
do that. It really worked for that family.’
Developing empathic responding skills
Gaining rapport with the client by using empathic reflections is an essential
skill (Forrester et. al., 2008) and an important part of the Egan model. A
group P student demonstrated she was able to reflect on using empathic
responses:
‘I worked with a person whose husband had been diagnosed with a
terminal illness. It was hard to get through to her. When she had
unloaded, I used the empathic response: ‘from what you have said to
me I think you are really scared and you are really trying to protect your
husband but you are worried about what is going to happen’. I didn’t
realise at the time but I said what she was feeling. And she got my
hands and kind of cried and that bit, I wasn’t actually comfortable with.
I think if I hadn’t used that response… I don’t think I would have been
where I was with that lady or her husband and I don’t think we would
have got things right to be perfectly honest so it was really useful for
that but on the other hand it took a bit of, you know….’
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The above participant has highlighted the effect of employing Egan’s skills of
fully engaging with what a client might be thinking and feeling. She
demonstrated how unused clients might be to a demonstration of
understanding at this level and also how challenging this was for her too.
Currer (2007) comments that social workers often find it difficult to respond to
strong emotional reactions from service users fearing opening the floodgates
and causing more harm than good. Assisting students to first anticipate and
then work with strong emotional reactions would need to be included in the
teaching of the Egan model.
Developing challenging skills
The model describes how to use challenging skills. However, challenging
was not alluded to so frequently by students and it seems this is a more
difficult aspect of the model with which to get to grips. Egan (2010) writes at
length about this area and states that good, effective challenging is essential
in helping clients to manage their situations better. Only one student (from
group P) discussed the area of challenging and it is clear that she was
hesitant in using this skill:
‘I think it’s about recognising when not to use it as well. I don’t know
whether it is because I recognised that it was not going to be useful or
that I was frightened of using it.’
Although the student demonstrated the ability to be reflective there is clearly a
difficulty in using challenging skills. Raising concerns by using challenging
skills distinguishes social work from counselling (Forrester et. al., 2008) and
as such, is an important skill for workers to develop. Assisting students to
develop confidence in practising challenging might be a useful development
with future groups.
Assisting service users to plan action
The study indicates that although some students found the first part of the
model (active listening skills) the easiest to remember, students who used all
three stages of the model experienced this as most beneficial in aiding clients
to action. One student from group P who worked with children with profound
learning disabilities demonstrated that using the model had had an effect on
both the client’s action and also on developing the relationship:
‘I started off using the first stage with children with their parents, talking
to them and using empathic responses when they are upset and I’ve
been building a relationship up with a parent to the point where in his
review he pointed out he had a good bond with me. We have started
with the little things and we are building up to the bigger things, for
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example getting pictures up on the walls. The little things build onto
the bigger things. It just seems to be working really well.’
The above point illustrates that students learn from the model to set goals with
their service users and that these goals do not have to be huge, small
changes are useful in themselves (Egan, 2010).
Debating the usefulness of the model
One student from group P felt that learning the Egan model had taught him
nothing new. He felt that he employed the skills naturally, stating:
‘There isn’t the chance to sit back and empathise, as good and as
useful as you would say that would be. We are doing a lot of the Egan
model anyway because it is what we do.’
The above student already had skills of which he was unaware but according
to Koprowska (2010) tutors need to help students to build on communication
skills they already possess. The comment above demonstrates that helping
students to develop conscious awareness of the difference between skills
they bring to the classroom already and new skill development based on
theory is a challenge for tutors. The student also highlighted time pressures
he was under and how he felt it was too time-consuming to use empathic
responses. However, other students commented that time spent using these
skills moved the client towards action and resolution more quickly. This will
be discussed later in the next section of this paper.
Keeping the service user at the centre of the process
Empowerment
The study sought to find out whether using the Egan model helped students to
place the service user at the centre of decision making. This was found to be
the case with the following group F student:
‘Reflections are much better than asking direct questions, you’re
prompting but it flows nicely. They are making their own decisions.
We’re asking them what they would like and the responses are a lot
better and we’re getting to action quite a lot quicker and they are
coming out thinking they’ve actually done the job. They’ve had their
own power there and made their own decisions and we’re just the
helpers.’
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Another student from group F also commented on how the model helped her
to place the service user at the centre of the process and the importance of
enabling the client to take control and search out a way of managing their
problem more successfully:
‘With one client we looked at where was she at now, and through that
we moved on to what does she need or want. She wasn’t attending
school and it turned out she was worried about what was going on at
home when she was at school and felt she couldn’t attend all day. We
talked about different options and in the end it turned out she does
want to stay in school and gain a diploma.
I like the model because they are finding the answer. She was saying
where she wanted to be. I felt because she had given a solution she
had gone from her head being down coming into the room, not really
wanting to engage to being upbeat, open: her complete body language
had changed.’
The same student illustrated that she can use the Egan model approach of
finding out what the client needs rather than telling the service user what to
do:
‘So much was going on in her life that you couldn’t really comprehend
to be honest, for someone of that age to be going through it, but deep
down she did want to stay in education and learnt that there was
something out there. I don’t want to criticise, but the person who has
been working with her has been telling her what she should be doing
and telling her if she didn’t do that how it was going to affect her. I
think that is why she has not engaged.’
Resisting problem solving
Learning the Egan model enabled students to curb their natural tendencies of
trying to solve things for the service user and of giving advice. Egan (2010)
writes about power and control in the relationship and how telling the service
user what they should be doing embeds this power differential. This is
reflected in the student’s comments above.
A group F participant demonstrated she could help the client to own their
progress and to move towards becoming a more independent decision maker
which is a key aspect of the model:
‘At the end of the day it is their life and if they have achieved that all
themselves with you helping them, then they can take all the credit for
that and it helps them feel better. And if they feel better and can see
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the possibilities that they could have and they achieve them
themselves: they are more likely to stick to that way of life and it’s more
positive for them.’
Another group F student demonstrated she had absorbed the model into her
way of working while at the same time reflecting on her struggle to stay within
the client’s frame of reference:
‘I use the model and let them talk but in the back of my head or when I
reflect, sometimes I think, ‘Oh God, please, just leave the relationship’
but you can’t say that. It is still there and I’ve got to do something
about that.’
The theme highlighted above is one of the barriers which tutors have
encountered in teaching the Egan Skilled Helper model, namely, helping
students to learn that their role is not to tell the client what to do but to find out
what the client wants or needs and from this to establish realistic and
achievable goals. Tutors work with students who frequently ask ‘But when
can we tell the client what to do?’ and ‘But what if you know what the client
ought to do?’ Helping students make this leap has been a challenge but one
which is fundamental to enabling students to place the service user at the
centre of decision making. This is an area that the Egan model addresses
clearly by emphasising that the client is the expert on themselves (Egan
2010).
Maintaining the transfer of knowledge from the classroom into practice
Each of the students demonstrated that they had absorbed and remembered
the skills they had learned and that they could employ these skills at a later
date, several months after the module ended. One group P student
demonstrated this by referring to stage three forcefield analysis which is a
method of helping the client to assess what would help them adhere to their
chosen strategy and what might hinder them in this process:
‘The bit I have used quite a bit is actually the last stage, looking at
change and using forcefield analysis and also possibilities where they
choose some and what will help them.’
Another student from group P demonstrated sustained knowledge by
commenting on Egan’s (2010) ‘SOLER’ technique (Sitting squarely, Open
body language, Leaning forward, maintaining Eye contact, staying Relaxed)
and also the latter stages of the model:
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‘I’ve used stages two and three in addition to the stage one skills. I’m
working with people with learning disability: we use a person-centred
approach. I’ve been helping people look at what they want to do and
formulating plans and the best way forward. The model has also had a
positive response from colleagues.’
Some students demonstrated they developed lasting skills in all three stages
of the model. One, an experienced practitioner from group P, talked about
how he had adopted the whole model and how this had had an impact on his
workplace practices over a period of time:
‘Managers come from outside saying ‘we are going to do this and that’
and you say ‘no’. It’s made you think, ‘no, you don’t do that: you’ve got
to listen to what they want’ so we’ve put that into practice quite a lot. It
has changed working practices. Really, it has. We imposed, or I
imposed my own wants, I wanted them to do things, as my own values,
‘you should be doing this and going there’ and now I step back and find
out what they want. I knew what they should be doing and am trying to
think differently. It is working and proving to be useful.’
The above example shows how this student’s values have been influenced by
the model. His analysis shows that this way of working is of value to both
himself as a helper and to the service user. His comments also illustrate that
a change in approach has been adopted and maintained by him in the
workplace.
More research into transferring skills from the classroom into the workplace is
planned. Students who took part in this study will be interviewed in their
second social work practice placement to establish whether their new
knowledge and skills have been maintained. Engaging interested practice
educators by teaching them the model is also planned. Including practice
educators would enable students to discuss their progress with the model
during supervision. Findings from this planned project will be discussed in a
future paper.
Discussion and Conclusion
The majority of the fifteen students who took part in the study commented that
using Egan’s Skilled Helper model improved their communication skills. The
students particularly liked the framework offered by the model of ‘where is the
client now, where do they want or need to be and how are they going to get
there.’ Having this ‘map’ gave them confidence and actual, practical ways of
working collaboratively with service users and placing them in charge of their
own lives. Many students early in their training struggle with the temptation to
tell service users what to do and it is encouraging that in this study
participants found that using the Egan model curbed these tendencies.
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Instead they worked collaboratively with clients to help them find ways of
managing their problems. Consequently they found there was a move
towards client self-determination more quickly. The importance of such
autonomy has been highlighted by a number of writers including Cambridge
(2004) and Cooper and Spencer-Dawe (2006). A key finding of the study is
that placing service users at the centre of decision making promotes earlier
resolution of issues. A further study will find out whether using the Egan
model enables cases to be closed more quickly.
Almost all of the study participants stated that using new skills contained in
the Egan model, such as empathic responding, has enabled them to engage
at a deeper level. Indeed, Forrester et.al. (2008) and the DCSF’s (2010)
recommendations were that advanced empathy was a vital skill to learn and
should be taught in communication skills modules. One project participant,
however, described her use of an empathic reflection and then spoke of her
subsequent discomfiture at the intense emotional reaction from the service
user. Therefore, a point to note is that in teaching the Egan model, students
need to be alerted to the possibility that using empathy can be overwhelming,
both for themselves and the service user. Training also needs to include skills
for working with strongly expressed emotions.
The participants’ discussion of how they used the Egan model demonstrates
how they have transferred their knowledge from the classroom into practice
settings. The five full-time students continued to give feedback on the model
throughout their first practice placement demonstrating that their learning from
year one was sustained into practice. The feedback from a whole group of
ten, employment-based, part-time students has also been useful in evaluating
how knowledge has been transferred because these students were already
experienced practitioners and held a case-load of service users. A key finding
is that these participants have been willing to change their approach by
putting into practice a new model. A further study is planned to establish
whether their new skills have been sustained over a longer period.
The study has limitations, mainly concerning its size which was governed
inevitably by the availability of students and their capacity to give time to the
project. The sample size was small and consisted of exclusively white
students, the majority of whom were female. Ashencaen Crabtree and Baba
(2001) comment that all Western counselling approaches extoll the
importance of individual needs and goals. They argue that in some cultures,
such as Islam, the needs of community outweigh those of self-interest and
that practitioners need to recognise such factors. Egan comments that his
theory may well not fit other cultures, or may need adaptation. However, he
also emphasises the importance of recognising diversity within cultures,
stating ‘clients are individuals, not subcultures or groups’ and that
practitioners need to use interventions which ‘factor in key cultural and
personal-culture variables’ (Egan, 2010: 51-52). Working with these
corollaries can be highly challenging for practitioners and since there is little
research in this area, further exploration would be useful.
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Another limitation is that the interest in the subject by the author (who also
taught the module) may have influenced the members of the focus group to
give more positive feedback than they would have given to an independent
third party (Robson, 2002). This constraint will be addressed in the next study
by the inclusion of an independent interviewer.
A criticism of the Egan model is that it assumes service users will be able to
communicate verbally. Indeed, Rowland and McDonald (2009) in their paper
on communication skills with service users who have aphasia (people who
cannot form words but who have cognitive understanding) raise the issue of
how social work students are taught to communicate with people who do not
have verbal skills. The authors emphasise the importance of enabling all
service users to be able to express their needs and voice their concerns, often
non-verbally. They also emphasise the crucial importance in these instances
of helpers using empathic responses. The Egan model places the service
user at the centre of decision making by encouraging the helper to first find
out their needs and then collaborate in establishing achievable goals. This
process does not have to consist of using purely verbal skills. More creative
approaches can be employed such as using symbols, artwork and advocacy
skills. One student in the study reported using the Egan model when working
with children with profound learning disabilities to establish what they needed
or wanted and this can be taken as a starting point to a more detailed
investigation in the future.
A planned development from the current project is to involve the same group
of students in assessing further the efficacy of the model including whether it
leads to cases being closed more quickly. It will also examine whether
students’ knowledge and skills from learning the model have been sustained
over time. A second planned project will find out whether learning could be
further embedded by involving practice educators. Trevithick et al (2004) in
their report for SCIE suggested social work educators should embed
communication skills into practice by working with practice educators and
service users in order to maximise student learning within practice itself.
Practice educators will have the opportunity to learn the model so that they
will be enabled to support the new sample of students who have volunteered
to give feedback on the Egan model during their placement. These projects
will explore further the usefulness of the Skilled Helper model in enabling
students to develop their communication skills.
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